Identification
- Summary
Dalteparin is a low molecular weight heparin used for the prophylaxis of thrombotic events in certain patients and prevent acute cardiac ischemic events in patients with unstable angina and non-Q-wave myocardial infarction.
- Brand Names
- Fragmin
- Generic Name
- Dalteparin
- DrugBank Accession Number
- DB06779
- Background
Dalteparin, a low molecular weight heparin (LMWH) prepared by nitrous acid degradation of unfractionated heparin of porcine intestinal mucosa origin, is an anticoagulant. It is composed of strongly acidic sulphated polysaccharide chains with an average molecular weight of 5000 and about 90% of the material within the range of 2000-9000. LMWHs have a more predictable response, a greater bioavailability, and a longer anti-Xa half life than unfractionated heparin. Dalteparin can also be safely used in most pregnant women. Low molecular weight heparins are less effective at inactivating factor IIa due to their shorter length compared to unfractionated heparin.
- Type
- Small Molecule
- Groups
- Approved
- Synonyms
- alpha-heparin
Pharmacology
- Indication
Dalteparin is used as a prophylaxis for deep-vein thrombosis and pulmonary embolisms in patients undergoing general surgery (e.g., abdominal, gynecologic, urologic), and in patients with acute medical conditions (e.g. cancer, bed rest, heart failure, severe lung disease). It is also used in patients who have severely restricted mobility, which poses a risk for thromboembolic complications.
Dalteparin is also used concomitantly with aspirin and/or other therapy (e.g., nitrates, β-adrenergic blockers, clopidogrel, platelet glycoprotein [GP] IIb/IIIa-receptor inhibitors) to reduce the risk of acute cardiac ischemic events. The patients who undergo this treatment combination have unstable angina or non-ST-segment elevation/non-Q-wave myocardial infarction (i.e., non-ST-segment elevation acute coronary syndromes).
It is also used in the prevention of clotting during hemodialysis and hemofiltration in connection with acute renal failure or chronic renal insufficiency.
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- Contraindications & Blackbox Warnings
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Dalteparin has an antithrombin binding site that is essential for high affinity binding to the plasma protein antithrombin (ATIII). Anti-Xa activity of plasma is used as both as an estimate of clotting activity, and as a basis to determine dosage. Its use should be avoided in patients with a creatinine clearance less than 20mL/min. In these patients, unfractionated heparin should only be used. As for monitoring, active partial thromboplastin time (aPTT) will only increase at high doses of low molecular weight heparins (LMWH). Therefore, monitoring aPTT is not recommended. However, anti-Xa activity can be measured to monitor the efficacy of the LMWH.
- Mechanism of action
Dalteparin potentiates the activity of ATIII, inhibiting the formation of both factor Xa and thrombin. The main difference between dalteparin and unfractionated heparin (UH) is that dalteparin preferentially inactivates factor Xa. As a result, only a slight increase in clotting time [(i.e. activated partial thomboplastin time (APTT)] is observed relative to UH. For this same reason, APTT is not used to monitor the effects of dalteparin except as an indicator for overdosage.
Target Actions Organism AAntithrombin-III potentiatorHumans AVascular endothelial growth factor A inhibitorHumans ATissue factor pathway inhibitor inhibitorHumans UP-selectin inhibitorHumans - Absorption
Almost completely absorbed after subcutaneous (sc) doses, with a bioavialability of about 87%.
- Volume of distribution
3 litres
- Protein binding
Less than unfractionated heparin, which is more than 90%.
- Metabolism
Liver and the reticulo-endothelial system are the sites of biotransformation. They are partially metabolized by desulphatation and depolymerization.
- Route of elimination
After 4 hours, about 20% is seen in urine. Most of the remainder is found in the liver, gastrointestinal tract and kidney. The kidneys are the major site of dalteparin excretion (approximately 70% based on animal studies).
- Half-life
Terminal Half life: Intravenous - 2 hours. Subcutaneous - 3-5hours
- Clearance
Excreted via kidneys. The plasma clearance rate is 33 mL/min.
- Adverse Effects
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Overdosage: hemorrhagic complications. Adverse Drug Reaction: (common) osteopenia with extended use; mild, reversible non-immunological thrombocytopenia; transient elevation of liver transaminases; alopecia. (uncommon): severe immunologically-mediated heparin-induced thrombocytopenia; anaphylactic reactions; skin rash, skin necrosis; retroperitoneal hemorrhage; angioedema
- Pathways
- Not Available
- Pharmacogenomic Effects/ADRs
- Not Available
Interactions
- Drug Interactions
- This information should not be interpreted without the help of a healthcare provider. If you believe you are experiencing an interaction, contact a healthcare provider immediately. The absence of an interaction does not necessarily mean no interactions exist.
Drug Interaction Integrate drug-drug
interactions in your softwareAbciximab The risk or severity of bleeding can be increased when Abciximab is combined with Dalteparin. Acebutolol The risk or severity of hyperkalemia can be increased when Acebutolol is combined with Dalteparin. Aceclofenac The risk or severity of bleeding and hemorrhage can be increased when Aceclofenac is combined with Dalteparin. Acemetacin The risk or severity of bleeding and hemorrhage can be increased when Dalteparin is combined with Acemetacin. Acenocoumarol The risk or severity of bleeding can be increased when Acenocoumarol is combined with Dalteparin. Acetylsalicylic acid Acetylsalicylic acid may increase the anticoagulant activities of Dalteparin. Albutrepenonacog alfa The therapeutic efficacy of Albutrepenonacog alfa can be decreased when used in combination with Dalteparin. Alclofenac The risk or severity of bleeding and hemorrhage can be increased when Alclofenac is combined with Dalteparin. Aldesleukin The risk or severity of bleeding can be increased when Dalteparin is combined with Aldesleukin. Alemtuzumab The risk or severity of bleeding can be increased when Dalteparin is combined with Alemtuzumab. 
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- Avoid herbs and supplements with anticoagulant/antiplatelet activity. Examples include garlic, ginger, bilberry, danshen, piracetam, and ginkgo biloba.
Products
Drug product information from 10+ global regionsOur datasets provide approved product information including:dosage, form, labeller, route of administration, and marketing period.Access drug product information from over 10 global regions.- Product Ingredients
Ingredient UNII CAS InChI Key Dalteparin sodium 12M44VTJ7B Not Available Not applicable - International/Other Brands
- Boxol (Pharmacia) / Eurodal (Gland) / Ligoframin (Pfizer) / Low Liquemine (Roche)
- Brand Name Prescription Products
Name Dosage Strength Route Labeller Marketing Start Marketing End Region Image Fragmin Injection 7500 [iU]/0.3mL Subcutaneous Eisai Limited 1994-12-22 2016-09-30 US 
Fragmin Injection 18000 [iU]/0.72mL Subcutaneous Pfizer Laboratories Div Pfizer Inc 2015-04-01 Not applicable US Fragmin Solution 3500 unit / 0.28 mL Intravenous; Subcutaneous Pfizer Canada Ulc 2015-03-25 Not applicable Canada 
Fragmin Injection 10000 [iU]/1mL Subcutaneous Pfizer Laboratories Div Pfizer Inc 2015-04-01 Not applicable US Fragmin Injection 2500 [iU]/0.2mL Subcutaneous Pfizer Laboratories Div Pfizer Inc 2015-04-01 Not applicable US Fragmin Solution 12500 unit / 0.5 mL Intravenous; Subcutaneous Pfizer Canada Ulc 2011-02-01 Not applicable Canada Fragmin Injection 18000 [iU]/0.72mL Subcutaneous Eisai Limited 1994-12-22 2016-09-30 US Fragmin Solution 25000 unit / mL Intravenous; Subcutaneous Pfizer Canada Ulc 1997-11-27 Not applicable Canada Fragmin Solution 10000 unit / mL Intravenous; Subcutaneous Pfizer Canada Ulc 1995-12-31 Not applicable Canada Fragmin Injection 10000 [iU]/1mL Subcutaneous Eisai Limited 1994-12-22 2016-09-30 US
Categories
- ATC Codes
- B01AB04 — Dalteparin
- Drug Categories
- Classification
- Not classified
- Affected organisms
- Not Available
Chemical Identifiers
- UNII
- S79O08V79F
- CAS number
- 9005-49-6
- InChI Key
- Not Available
- InChI
- Not Available
- IUPAC Name
- Not Available
- SMILES
- Not Available
References
- General References
- King DJ, Kelton JG: Heparin-associated thrombocytopenia. Ann Intern Med. 1984 Apr;100(4):535-40. [Article]
- Bell WR, Royall RM: Heparin-associated thrombocytopenia: a comparison of three heparin preparations. N Engl J Med. 1980 Oct 16;303(16):902-7. [Article]
- Ockelford PA, Patterson J, Johns AS: A double-blind randomized placebo controlled trial of thromboprophylaxis in major elective general surgery using once daily injections of a low molecular weight heparin fragment (Fragmin). Thromb Haemost. 1989 Dec 29;62(4):1046-9. [Article]
- Hartl P, Brucke P, Dienstl E, Vinazzer H: Prophylaxis of thromboembolism in general surgery: comparison between standard heparin and Fragmin. Thromb Res. 1990 Feb 15;57(4):577-84. [Article]
- Monreal M, Lafoz E, Salvador R, Roncales J, Navarro A: Adverse effects of three different forms of heparin therapy: thrombocytopenia, increased transaminases, and hyperkalaemia. Eur J Clin Pharmacol. 1989;37(4):415-8. [Article]
- Holmer E, Soderberg K, Bergqvist D, Lindahl U: Heparin and its low molecular weight derivatives: anticoagulant and antithrombotic properties. Haemostasis. 1986;16 Suppl 2:1-7. [Article]
- Malm K, Dahlback B, Arnljots B: Low-molecular-weight heparin (dalteparin) effectively prevents thrombosis in a rat model of deep arterial injury. Plast Reconstr Surg. 2003 Apr 15;111(5):1659-66. [Article]
- Tincani E, Mannucci C, Casolari B, Turrini F, Crowther MA, Prisco D, Cenci AM, Bondi M: Safety of dalteparin for the prophylaxis of venous thromboembolism in elderly medical patients with renal insufficiency: a pilot study. Haematologica. 2006 Jul;91(7):976-9. Epub 2006 Jun 1. [Article]
- Schmid P, Brodmann D, Fischer AG, Wuillemin WA: Study of bioaccumulation of dalteparin at a prophylactic dose in patients with various degrees of impaired renal function. J Thromb Haemost. 2009 Apr;7(4):552-8. doi: 10.1111/j.1538-7836.2009.03292.x. Epub 2009 Jan 19. [Article]
- Abe W, Ikejima K, Lang T, Okumura K, Enomoto N, Kitamura T, Takei Y, Sato N: Low molecular weight heparin prevents hepatic fibrogenesis caused by carbon tetrachloride in the rat. J Hepatol. 2007 Feb;46(2):286-94. Epub 2006 Oct 25. [Article]
- Frydman A: Low-molecular-weight heparins: an overview of their pharmacodynamics, pharmacokinetics and metabolism in humans. Haemostasis. 1996;26 Suppl 2:24-38. [Article]
- Samama MM, Gerotziafas GT: Comparative pharmacokinetics of LMWHs. Semin Thromb Hemost. 2000;26 Suppl 1:31-8. [Article]
- Rey E, Rivard GE: Prophylaxis and treatment of thromboembolic diseases during pregnancy with dalteparin. Int J Gynaecol Obstet. 2000 Oct;71(1):19-24. [Article]
- External Links
- KEGG Drug
- D03353
- PubChem Substance
- 347910371
- 67109
- Wikipedia
- Dalteparin_sodium
Clinical Trials
- Clinical Trials
Phase Status Purpose Conditions Count 4 Completed Prevention Arthritis of the Hip / Infection / Transfusion Related Complications / Wound Discharge 1 4 Completed Prevention Coronavirus Disease 2019 (COVID‑19) / COVID / Deep Vein Thrombosis / Pulmonary Embolism / Thrombosis 1 4 Completed Prevention Deep Vein Thrombosis / Pulmonary Embolism 2 4 Completed Prevention Kidney Failure 1 4 Completed Treatment Cancer 1 4 Completed Treatment Deep Vein Thrombosis 1 4 Completed Treatment Lower Extremity Superficial Thrombophlebitis / Superficial Thrombophlebitis / Upper Extremity Superficial Thrombophlebitis 1 4 Completed Treatment Lung Cancer 1 4 Completed Treatment Pancreatic Cancer / Venous Thromboembolism 1 4 Completed Treatment Superficial Thrombophlebitis 1
Pharmacoeconomics
- Manufacturers
- Not Available
- Packagers
- Not Available
- Dosage Forms
Form Route Strength Solution Subcutaneous 5000 IU Injection Subcutaneous 10000 [iU]/1mL Injection Subcutaneous 10000 [iU]/0.4mL Injection Subcutaneous 12500 [iU]/0.5mL Injection Subcutaneous 15000 [iU]/0.6mL Injection Subcutaneous 18000 [iU]/0.72mL Injection Subcutaneous 2500 [iU]/1mL Injection Subcutaneous 2500 [iU]/0.2mL Injection Subcutaneous 25000 [iU]/1mL Injection Subcutaneous 5000 [iU]/0.2mL Injection Subcutaneous 7500 [iU]/0.3mL Injection, solution Subcutaneous Solution Intravenous; Subcutaneous 10000 unit / mL Solution Intravenous; Subcutaneous 10000 unit / 0.4 mL Solution Intravenous; Subcutaneous 12500 unit / 0.5 mL Solution Intravenous; Subcutaneous 15000 unit / 0.6 mL Solution Intravenous; Subcutaneous 16500 unit / 0.66 mL Solution Intravenous; Subcutaneous 18000 unit / 0.72 mL Solution Intravenous; Subcutaneous 2500 unit / mL Solution Intravenous; Subcutaneous 2500 unit / 0.2 mL Solution Intravenous; Subcutaneous 25000 unit / mL Solution Intravenous; Subcutaneous 3500 unit / 0.28 mL Solution Intravenous; Subcutaneous 5000 unit / 0.2 mL Solution Intravenous; Subcutaneous 7500 unit / 0.3 mL Injection, solution Intravenous; Subcutaneous 10000 IU/ml Injection Parenteral Injection, solution Parenteral 10000 IE Injection, solution Parenteral 10000 IE/ML Injection, solution Parenteral 10000 IU Injection, solution Parenteral 12.500 IE Injection, solution Parenteral 12500 IE Injection, solution Parenteral 15000 IE Injection, solution Parenteral 18000 IU Injection, solution Parenteral 18000 IE Injection, solution Parenteral 2.500 I.E. Injection, solution Parenteral 2.500 IE Injection, solution Parenteral 2500 IU Injection, solution Intravenous; Subcutaneous 25000 IU/ml Injection, solution Parenteral 2500 I.E. Solution Subcutaneous 2500 IU Solution Parenteral; Subcutaneous 2500 IU Injection, solution Parenteral 2500 IE Injection, solution Parenteral 5.000 I.E. Injection, solution Parenteral 5000 I.E. Injection, solution Parenteral 5000 IE Injection, solution Parenteral 7500 IU Injection, solution Parenteral 7.500 IE Solution Subcutaneous 7500 IU Injection, solution Parenteral 7500 IE Liquid Intravenous; Subcutaneous 2500 unit / mL Injection Intravenous; Subcutaneous 10000 iu/ml Injection Subcutaneous 2500 iu/0.2ml Injection Intravenous 2500 iu/ml Injection Subcutaneous 25000 iu/ml Injection Subcutaneous 5000 iu/0.2ml Injection, solution Parenteral 5000 IU Injection, solution Parenteral 5.000 IE Solution Subcutaneous 10000 IU Injection, solution 12500 IU/mL Injection, solution 25000 iU/mL - Prices
- Not Available
- Patents
- Not Available
Properties
- State
- Solid
- Experimental Properties
- Not Available
- Predicted Properties
- Not Available
- Predicted ADMET Features
- Not Available
Spectra
- Mass Spec (NIST)
- Not Available
- Spectra
- Not Available
Targets
- Kind
- Protein
- Organism
- Humans
- Pharmacological action
- Yes
- Actions
- Potentiator
- General Function
- Serine-type endopeptidase inhibitor activity
- Specific Function
- Most important serine protease inhibitor in plasma that regulates the blood coagulation cascade. AT-III inhibits thrombin, matriptase-3/TMPRSS7, as well as factors IXa, Xa and XIa. Its inhibitory a...
- Gene Name
- SERPINC1
- Uniprot ID
- P01008
- Uniprot Name
- Antithrombin-III
- Molecular Weight
- 52601.935 Da
References
- Frydman A: Low-molecular-weight heparins: an overview of their pharmacodynamics, pharmacokinetics and metabolism in humans. Haemostasis. 1996;26 Suppl 2:24-38. [Article]
- Rey E, Rivard GE: Prophylaxis and treatment of thromboembolic diseases during pregnancy with dalteparin. Int J Gynaecol Obstet. 2000 Oct;71(1):19-24. [Article]
- Kind
- Protein
- Organism
- Humans
- Pharmacological action
- Yes
- Actions
- Inhibitor
- General Function
- Vascular endothelial growth factor receptor binding
- Specific Function
- Growth factor active in angiogenesis, vasculogenesis and endothelial cell growth. Induces endothelial cell proliferation, promotes cell migration, inhibits apoptosis and induces permeabilization of...
- Gene Name
- VEGFA
- Uniprot ID
- P15692
- Uniprot Name
- Vascular endothelial growth factor A
- Molecular Weight
- 27042.205 Da
References
- Norrby K, Nordenhem A: Dalteparin, a low-molecular-weight heparin, promotes angiogenesis mediated by heparin-binding VEGF-A in vivo. APMIS. 2010 Dec;118(12):949-57. doi: 10.1111/j.1600-0463.2010.02635.x. Epub 2010 Oct 12. [Article]
- Marchetti M, Vignoli A, Russo L, Balducci D, Pagnoncelli M, Barbui T, Falanga A: Endothelial capillary tube formation and cell proliferation induced by tumor cells are affected by low molecular weight heparins and unfractionated heparin. Thromb Res. 2008;121(5):637-45. Epub 2007 Aug 10. [Article]
- Takahashi H, Ebihara S, Okazaki T, Asada M, Sasaki H, Yamaya M: A comparison of the effects of unfractionated heparin, dalteparin and danaparoid on vascular endothelial growth factor-induced tumour angiogenesis and heparanase activity. Br J Pharmacol. 2005 Oct;146(3):333-43. [Article]
- Kind
- Protein
- Organism
- Humans
- Pharmacological action
- Yes
- Actions
- Inhibitor
- General Function
- Serine-type endopeptidase inhibitor activity
- Specific Function
- Inhibits factor X (X(a)) directly and, in a Xa-dependent way, inhibits VIIa/tissue factor activity, presumably by forming a quaternary Xa/LACI/VIIa/TF complex. It possesses an antithrombotic action...
- Gene Name
- TFPI
- Uniprot ID
- P10646
- Uniprot Name
- Tissue factor pathway inhibitor
- Molecular Weight
- 35014.835 Da
References
- Mousa SA: Low-molecular-weight heparins in thrombosis and cancer: emerging links. Cardiovasc Drug Rev. 2004 Summer;22(2):121-34. [Article]
- Naumnik B, Rydzewska-Rosolowska A, Mysliwiec M: Different effects of enoxaparin, nadroparin, and dalteparin on plasma TFPI during hemodialysis: a prospective crossover randomized study. Clin Appl Thromb Hemost. 2011 Oct;17(5):480-6. doi: 10.1177/1076029610376936. Epub 2010 Aug 3. [Article]
- Bendz B, Andersen TO, Sandset PM: Dose-dependent release of endogenous tissue factor pathway inhibitor by different low molecular weight heparins. Blood Coagul Fibrinolysis. 2000 Jun;11(4):343-8. [Article]
- Kind
- Protein
- Organism
- Humans
- Pharmacological action
- Unknown
- Actions
- Inhibitor
- General Function
- Sialic acid binding
- Specific Function
- Ca(2+)-dependent receptor for myeloid cells that binds to carbohydrates on neutrophils and monocytes. Mediates the interaction of activated endothelial cells or platelets with leukocytes. The ligan...
- Gene Name
- SELP
- Uniprot ID
- P16109
- Uniprot Name
- P-selectin
- Molecular Weight
- 90833.105 Da
References
- Rey E, Rivard GE: Prophylaxis and treatment of thromboembolic diseases during pregnancy with dalteparin. Int J Gynaecol Obstet. 2000 Oct;71(1):19-24. [Article]
Enzymes
- Kind
- Protein
- Organism
- Humans
- Pharmacological action
- Unknown
- Actions
- Substrate
- General Function
- Syndecan binding
- Specific Function
- Endoglycosidase that cleaves heparan sulfate proteoglycans (HSPGs) into heparan sulfate side chains and core proteoglycans. Participates in extracellular matrix (ECM) degradation and remodeling. Se...
- Gene Name
- HPSE
- Uniprot ID
- Q9Y251
- Uniprot Name
- Heparanase
- Molecular Weight
- 61148.17 Da
References
- Takahashi H, Ebihara S, Okazaki T, Asada M, Sasaki H, Yamaya M: A comparison of the effects of unfractionated heparin, dalteparin and danaparoid on vascular endothelial growth factor-induced tumour angiogenesis and heparanase activity. Br J Pharmacol. 2005 Oct;146(3):333-43. [Article]
Drug created at September 14, 2010 16:21 / Updated at March 21, 2023 17:58